While evaluating a child with neonatal cholestasis, the most important priority is to exclude biliary atresia and causes like galactosemia which needs early diagnosis and treatment.
- Conjugated hyperbilirubinemia
- Serum direct /conjugated bilirubin concentration greater than 1.0 mg/dL if the total serum bilirubin (TSB) is <5.0 mg/dL or greater than 20 percent of TSB if the TSB is >5.0 mg/dL.
- Conjugated hyperbilirubinemia at any age in a newborn is pathological and requires evaluation.
- Serum transaminases(SGOT/AST & SGPT/ALT) are sensitive indicators of hepatocellular injury, but lack specificity and prognostic value.
- Gamma-glutamyl transpeptidase (GGTP) is a marker of biliary obstruction and is elevated in most cholestatic disorders
- Complete blood counts with PBF Cholestasis with hemolysis is seen in galactosemia, Coomb’s positive giant cell hepatitis etc.
- Ultrasound especially to rule out choledochal cyst.
- Urine non-glucose reducing substance (NGRS) can be used as a screening test in a suspected case of galactosemia – CLICK HERE TO READ POST ON GALACTOSEMIA